PROGNOSIS 



1275 



2. Complement Fixation. — Levaditi and Muttermilch have applied the 

 Bordet-Gengou reaction to trypanosorae infections. According to them, 

 the complement can be fixed by using as antigen an extract of trypanosomes 

 separated from red cells. 



3. Levaditi and Muttermilch' s Leucocytic Attachment Reaction. — Levaditi and 

 Muttermilch have shown that trypanosomes treated with the specific serum 

 (heated at 53° C.) develop a property of becoming attached to leucocytes, 

 and that this phenomenon is specific. The test may be used for identifying 

 a trypanosome or for diagnosis, but, according to La vera n and Mesnil, is 

 not very reliable in the case of C. castellanii infections. 



Attempts have been made to evolve agglutination reactions, trypanolytic 

 precipitin, and other biological tests for purposes of the diagnosis of sleeping 

 sickness, but so far with little success. 



Prognosis. — -The prognosis is serious, but not quite so serious as 

 it was before the introduction of atoxyl and the mixed atoxyl 

 tartar emetic treatment. If the patient is in the early stage, and 

 can be removed from the endemic area and put under good hygienic 

 conditions and atoxyl treatment, the disease may be cured, or 

 at least a marked improvement may be obtained. Great care, 

 however, is necessary before saying that a patient is really cured, 

 and at least two blood injections into susceptible animals should 

 be performed before giving a decided opinion. If, however, the 

 patient is compelled to live in the endemic area, and cannot be 

 treated with atoxyl, the outlook is most hopeless. It is to be noted 

 that there are several strains or varieties of different virulence. The 

 Uganda and French Congo strains caused by C. castellanii, as noted 

 by Laveran and Mesnil, cause a more acute type of the disease than 

 the Gambia strain due to C. gambiensis, and C. rhodesiensis is in 

 laboratory animals more virulent than C. castellanii, and the disease 

 caused by it in man runs a more rapid course. 



Treatment. — The only medicaments which have been so far found 

 to be of any real value are, first, arsenic in the form of atoxyl, and, in 

 a less degree, antimonium in the form of tartar emetic, the best 

 methodof treatment being a combined treatment wit hi he Iwo drugs. 



Atoxyl. — ^We recommend 2 to 3 grains of atoxyl by intramuscular 

 injection every third day for at least two years, or 0-3 gramme every 

 fourth day for the same period, with o-i gramme for a child ten years 

 old. 



Borden and Rodhain's method is y-S- grains of atoxyl by intramuscular 

 injection every fifth day. Koch recommended the subcutaneous injection of 

 7| grains gramme) on two successive days every ten days for two months, 

 when the treatment is to be stopped until further symptoms develop, and 

 when this occurs the treatment should be repeated. The drug can be obtained 

 or imported from any chemist in sterile vials ready for hypodermic medication. 

 The injection of atoxyl is occasionally followed by a febrile reaction, due, 

 according to some observers, to the absorption of products of trypanolysis. 



/ONa 



Atoxyl is sodium-^-aminophenyl arseniate — NH2GgH4AsOs; — and 



\OH 



contains from 25*q5 to 20*78 per cent, of arsenic, according to the amount of 



/ONa 



water of crystallization. Mono-acetylated atoxyl is CHgCONHC^HgAsO^' 



\OH 



According to Mesnil and Nicolle's observations, and the more recent observa- 



